Eye Injuries

Chapter 25

Anatomy of the Eye

Eye Injuries

• Can produce severe complications• Examine pupil for shape and reaction (if you

can see it)

Appearance of Eye

• In a normal, uninjured eye, the entire circle of the iris should be visible

• Pupils should be round, equal in size, react equally when exposed to light

• Both eyes should move in same direction when following a finger

• Always note patient’s signs and symptoms including severity and duration

Airway and Breathing

• Consider immobilization• Eye injuries can affect airway• Check for clear, symmetric breath sounds• Provide high-flow oxygen• Palpate chest for DCAP-BTLS

Circulation

• Quickly assess pulse rate and quality.• Control bleeding• Do not put pressure on eye• Wounds around eye:– bleed freely– Are not usually life threatening– Usually easy to control

Transport Decision

• Eye injuries are serious• Transport quickly and safely• Surgery/restoration of circulation to eye may

need to be achieved in 30 minutes• Do not delay transport

Physical Exam• Rapid physical exam

– In bleeding cases, do not focus just on bleeding.

– Quickly assess entire patient from head to toe.

• Focused physical exam– Begin with eyes and face– Assess eyes for equal gaze– Check pupil shape and response to light– Assess globe for bleeding– If eye is swollen shut, do not attempt to

open

Baseline Vital Signs/SAMPLE History

• Baseline vital signs– Monitor for shock

• SAMPLE history– Perform as usual; obtain from responsive patient

or family/bystanders• Interventions:– Provide complete spinal immobilization– Be cautious in bandaging

Foreign Objects in the Eye

• For small foreign objects lying on the surface of the eye, irrigate with saline

• Flush from the nose outward

Removing a Foreign Object from Under the Eyelid

• Never attempt to remove an object on the cornea

• Have the patient look down

• Place a cotton-tipped applicator on the outer surface of the upper lid

• Pull the lid upward and forward• Gently remove the foreign object from the

eyelid with a moistened, sterile applicator

Foreign Objects Impaled in the Eye• If there is an object impaled in the eye, do not remove it• Immobilize the object in place• Prepare a doughnut ring by wrapping a 2” piece of gauze

around your fingers and thumb• Remove the gauze from your hand and wrap remainder

of gauze around ring• Carefully place the ring over the eye and impaled object,

without bumping the object • Stabilize the object with roller gauze• Cover the injured and uninjured eye

Chemical Burns

• Chemicals, heat, and light rays can burn the eye

• For chemicals, flush eye with saline solution or clean water

• You may have to force eye open to get enough irrigation to eye

• With an alkali or strong acid burn, irrigate eye for about 20 minutes

• Bandage eye with dry dressing

Irrigating the Eye

Thermal Burns

• For thermal burns, cover both eyes with a moist, sterile dressing.

• Transport patient to a burn center

Light Burns

• Infrared rays, eclipse light, direct sunlight, and laser burns can damage the eye

• Cover each eye with a sterile pad and eye shield

• Transport the patient in a supine position

Lacerations• Lacerations to the eyes

require very careful repair

• Never exert pressure on or manipulate the eye

• If part of the eyeball is exposed, apply a moist, sterile dressing

• Cover the injured eye with a protective metal eye shield

Blunt Trauma

• Blunt trauma can cause a number of serious injuries.– A fracture of the orbit

(blowout fracture)– Retinal detachment

• May range from a black eye to a severely damaged globe

Hyphema

• Bleeding in the anterior chamber of the eye

• May seriously impair vision

Blowout Fracture

• May occur from blunt trauma caused by a fracture of the orbit

• Bone fragments may entrap muscles that control eye movement, causing double vision

Retinal Detachment

• Often seen in sports injuries

• Produces flashing lights, specks, or floaters in field of vision

• Needs prompt medical attention

Eye Injuries Following a Head Injury

• One pupil larger than the other• Eyes not moving together or pointing in

different directions• Failure of the eyes to follow equally– Bleeding under the conjunctiva– Protrusion or bulging of one eye

Pupil Size and Head Injury

• Variation in pupil size may indicate a head injury

Contact Lenses and Artificial Eyes

• Contact lenses should be kept in the eyes unless there is a chemical burn

• Do not attempt to remove a lens from an injured eye

• Notify the hospital if the patient has contact lenses

• If there is no function in an eye, ask if the patient has an artificial eye

Contact Lens Removal

• If absolutely necessary, remove a hard contact lens with a small suction cup, moistening the end with saline

• To remove a soft contact lens:– Place two drops of normal

saline in eye– Gently pinch it between your

gloved thumb and index finger– Lift it off surface of eye